HomeMy WebLinkAbout04-20-15 (2) 21 l �-�z�9
ANNITAL REPORT OF
GUARDIAN OF THE ESTATE
COURT OF CO[o4v10N PLEAS OF c� � � m
m c�
° CUMBERLAND COUNTY, PENNSYLVAN�A � � o �
ORPHANS' COCIRT DNISION �� T� � �' _'n o
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Estate of %��� / � /" / vL� f � .an IncaQacttate�Pecsan�
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No.� � �C ��/�� �. � s c� �
I. WTROD/�UCTION
/�li/.�P/� � f �//t/ ��Ul� �- ,was appointed
.. �Plenary ❑Limit d Guardian ofthe Estate by Decree of T�6E' {yG��i a���J.,
� dated � � a` . ,
6 ❑ A. This is the Annual Report for the period from
to , (the"Report Period"); or
�B. This is the Final Report for Ute period from �
to � 31�(the"Report Period"),and is filed
�
for the foll ing reason:
I. The death of the Incapacitated Person.�ate of death:.L��o��/�
Name of Personal Representative: /�i(/�P�PT,� /L/ 1J�'� �
2. The Guardianship was terminated by the Court by Decree of
J.,da[ed
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��
��I
Estate of /�G��.�T C� �l/��'e—� ,An Incapaci�a[ed Person
II. 5[JMMARY
A. State[he value of the estate reported on[he Inventory $ � �
B. Sts[e the value(s) of principal assets at the beginning of � Qv�// a,j-'� 9�
the Report Period. (Same as Imentory if first RepoR,
otherwise,ending balance from last Report.) $
� C. What is the total amount of income earned during the --` (
' Report Period? $ e,i Tir7�
" D. What is the total amount of inwme and principal �
spent for all purposes during the Report Period? $ � � ' °'�—
. �j/N,9'Y�
E. What are the balances remaining at the end of the Report
Period? O
1. Principal $
2. Income $ �
� 3. Total of Principal and Income $ 0.00
iII. ADDTTIONAL INFORMATION
(ljmore space is needed,please anach additlonal pages.)
A. Principal
1. How is the principal balance listed above curtently
� imested? (Please specify,e.g.,real estate,
certificates of deposit,restricted bank accounts,etc.):
ai+/ /�e,E-r'N W/�S �/z,�Ns Fc'/Z,��Op To
.. Sv2�i� v�NG— sPaos�
2. Have there been any expenditures from the principal
during the Report Period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . es �No
lf yes:
� a. Have alf expenditures from the principal been for
the sole benefit of the Incapacitated Person? . . . . . . . . es ❑No
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Estate of , An Incapacitsted Person
� b. List purpose�and amount of expenditures:
$ 7�
, $
—°-7 $
$
c. Was Court approval received prior to
expending the principal? . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes o
3. Were additional principal assets received during the
Report Period which were not included in the
Imentory 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 o
b. Stete the sources and amaunts of[he
� additional principal received:
$
$
$
. $
$
B. Income
1. State sources and amounis of income received
during the Report Period (e.g., Sacial Security,
pensj�on,rep�tc.� ��
�_" ��:
��. ,�.� �� $
�i 2 ,��,, $�� _ri�=
� $
$
$
s
� Total income received during Report Pe�iod: $� '�
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Estate of An Incapacita[ed Person
2. How is income curtently invested? (Please
specify,e.g., restricted bank accounts,cliert
care account, etc.): ��—
./l�'Z� ,/y"c''+�' (iu�
C. Eapeoses for Care aod Msintenance
�� Specify what expendi[ures were made finm the principal and
income for the care and maintenance of the[ncapacitated
� Person (e.g.,clothing,nursing home,medicine,support,etcJ:
/��yJG c.,� L
� ,�,�Q � � �,��� ���,<<y
���� �
CL� 7��GN�� `� �G.
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.)
��ti��
"� E. Guardisds Commissions
List amounts of compe�sation paid as Guardian's commission
. and stau how amount was detelmined:
Court
Amount Method ojDetermination Approval Obtained
Cj . f�(j ❑Yes ❑No
DYes ❑No
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� Estate of �G/✓�P� T � �lUl./-�— , An Incapacitated Person
F. Counsel Fee
„ List amoun[s paid as counsel fee,and indica[e whether Court approval was obtained.
Cour!
� Amount Approva[Obtained
Qr W ❑Yes ❑No
❑Yes ❑No
1 verify that the foregoing information is correct to the best of my knowledge,
information and belief; and that this Verification is subject to the pe�alties of 18 Pa.C.S. § 4904 �
relative to unswom falsification to authorities.
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Namv o/Guardian o/(he Eemrc(rype wpnv)
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COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COUR'C DNISION
/� � an Incapacitated Person
Estaleof /1 C/�i /�/� i Ti- h�/l�—+ �aMinor
xo. so �c �o/�- C 02C�,95�/�
�/�6//��
i
� 1. Real Estate: (Locafion,by whom occupied and rentsl Esfimated Valoe:
terms,if applicabk)
SubTota/for Rea(Estate: o��
2. Personal Properly: Estimated Value:
3. Jointly Held Property: Estimated Value: U�
. ��Jo.n�,�i�ap:.w�w�a�arow„=eeyn,.n,.'o�nmdre..w��o�rvrcr.;m r
oNerperaon(aJ. Suuwherherheldafre.wnnDyiluennreeer;frotwM�herderighto/
}urvivorsNOuisal
JeinllyHddProyerq�
UD
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. Esta[e of��f���/t� T_ l� • �-1 C�GI"l— lua�..��.,ayae.e..,� . .,,o..��
'1❑a Minor
� 4. AnNcipated Assets: Estimated Value:
�«,nx yoy�.ly l�y qwe�rredro be a�yvi.utMrc her.�o��x�rwuh
m�ncf yared dan ofa4memonJ
b
Anyerry AnaripledD�e
oJAryxidmn
- SulrTota!jor Personnl Estate: 0.00
(Attach additional sheets if necessary)
TOTAL OF TTEMS 1,2,3,and 4: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.00
Commonwealth of Pennsylvania :
: ss.
County of CL�1�ei�'LA�.(i./J
� . l/C/•�l�f ��T �- �t/f('�-- . says that the foregoing is a full,
GumCian �/
true end complete Inventory of the Estate of GC(l/�J�i�T C/ �/ G�/C . _
the aforesaid Incapacitated Person or MinoG and that aIl of ihe information set foRh herein is
� irue and correct to the bes[of the Guardian's knowledge and belief.
I verify that the sretements made in this )
Inventory are we and correct. I under- )
stand that false statements herein are ) ���Ci��
made subjec[to the penalties of ) �
18 Pa.GS. §4904 rela[ing to unswom ) Guardian
falsification to authorities. )
Attomey for Guardian:
Supreme Court I.D.No.:
Address:
� Telephone:
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