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Home My WebLink About04-10-15 �►w � � AN'VL'AL RF.PORT OF � � o o � GUARDIA� OF TH� P�RSON o � �4 �� e ° a � � 0 COCKT OF CONIMON PLEAS OF � � � O � �U�✓hLJP/ �Q-+'�eL COOVTY, PCNNSYI.VANIA � � ORPHAtiS COIiR1 DNISION Estate of 17� 'r ryl t��O��GI �� , an Incapacitated Yerson —� No. C�L Z� - IZ - ( 320 I. INTRODUCTION � �Z f✓ � �Y� � � , was appoin[ed �Plenary❑Limited Quacdian of the Person by Dea'ee of � ��'S ��C✓�� ,J., dated �� ) 3 �A. This is the Annual Report for t e period from uGY , D L �a '—r^ –"„-��,,, ZO l �, (the "Repoct Period" ; or �i L P r/�- C✓ ❑ B. This is the Final Report Cor[hc pzriod Trom . �a , (the "Report Neriod"), and is filed for die following�eason: - I. Thc death of thc lncapacitatcd Person. llntc of dcath: 2. Thc Guardianship was tcrminated by thc Court by Decree of I., datcd For a Ft�inl Repor�, omlt Sec[ions I[througH IV. Pa e I oC4 � Fo.mG-03 rrn.lOJl.06 �' Es'ta[e of �e �U �Uu�p�j/.�cr� , �m [ncapacita[cd Person II. PERSONAL D9TA ry 07 Agc of the Incapaci[a[ed Persore___p (p Date of L3irth:_� - — Zc� III. LIVINGARRANGEMEN'fS A. Cur�ent address oC[he Incapnacitated Perso`n�: ,,"� " � ('lU ✓ C� 11 r Gc�o� /-+-��• � gu J N k�,.�� a✓ St- Curl � � le P� 17 � / 3 Q. The Incapacitzted Person's residence is: ❑own home/apartmen[ Qf nursing home ❑boarding home/personal care home ❑Guardiads home/apartmcnt ❑hospital o� medical facility ❑relative's hoine (name, rclationship and address) ❑other: C. The ]ncapacitated Person has been in the present residence since��( Z . If[he Incapaci[ated Person has moved wi[hin the past year, state prior �esidence and renson(s) for inove: Fo��n,c-o3 .e��_io�a.oe Page 2 of 4 8statc of �f� t li1 ( v �a.�1L� , an Incap�citared Pcrson The reasons for the foregoing opinion are: S VlG I S (.�^"G�-�o ��.' � �2� t.t.�1�t�l ( t��t,L � � �n a� e r`u.� , v� �r�-c� �#�s Vy n-.wVt_ i,�vtr� Gu_-�'�(' s ,'c�v�-o B. During the past ycar, [he Guacdian of the Person has visited the �ncapacitated Pecson �[imes with [hc avecage visit lasting � hours, O minu[cs. The report of n socin[se�vire orgonization employed by Ihe Gunrdion to nversee and caordinate the rvre of�he Incapacitated Person Jor the period covered by[his ltepar[ may be attaehed to supplement this Report_ 1 verify [hat thc foregoing information is corrcct to [he best of my knowledgc, information and belief; and [hat this Verification is subjec[to Ihe penal[ies of 18 Pa. C.S.A. §4904 relative to unswom falsifica[ion to authori[ies. 3 I z5 I � S t� � z �-�- oor� s�„a�,,e Ic„a.n,�,�oI , o„ � �e� � � �� Nome ofCunrdinn a/ihe N ron(rype orprinrJ 3z �G. � VAr� /�YC— nad.es�� ur <<� le- �A 17�7/ S o�r.s,��r.z,q '! � 7 - 38s - 7s93 7��,,�,�� FormC-03 ree. ]p13.06 P2ge40f4 Fstflte of �f � �v��E�� , an Incapacitatei Pecson D. Name and address or die Incapacitated Pcrson's primaq� caregiver 5 � a� � Ll.(�(.1�'!'i� c / ��h� `f�'�_ N. MEDICAL 1NFORMATION A. The major medical or mental problems of the Incapacitaced Person are as follows: �,le�e .�'a • �eer��( rr, vasC�-�a,� �� Pase COPi� s �� , � qFF«+-, �-� d ,.s� f�-` ��,��v �«� � ✓ e e,u�✓t,,,�f- n n e-+A �.-�a B. Speeify what, if any, social, medical, psychological and support serviees Ihe Incapacilatcd Person is rccciving: �O (/�� CG(/�.L � /�L tY S1�✓Iq ✓L�Y� 1/'Cqnt� 0/t- �-(t Cl�+✓ �/t�S r `'( � J . J S �er� ��-c � ��'S � t-s u.r�'�-t� psycl� � � f�—i � Vl.(.�/JL �✓a� �� c.n✓tF✓ ��I1 �1.f✓, c, �/� s ,{-S V. GUARDIAN'S OPINION A. Itisthe opinion ofthe Guardinn ofthe Ferson tha[the guacdianship should�, �can[inue ❑bc modified �be terminated i�o.��c-m ,e.. m.�a.oe Page 3 of4 � � a � ANVUAL REPORT OF �� '�' GUARDIAv OF THE ESTATE o � �o o� � ° COURT Or COMMON PLF�S OF �'v�-,� � �� "� ��✓I �'v.0 COUNTY, PENVSYLVANI;1 � J ORPHA�'S COURT DLVISION Es[ate of_ �'J C�� cy GZJ(�/ho✓�C� , an Incapacita[ed Pe�son � 7vo. bG - ZI — IZ — � 3Zd I. INT20llUCTIOH ��`-� � f�� , was appointed �Plenary ❑Limi[ed GuardianoCtheF,statebyDecrccoC_ f� M�ClS �Cc�� , J., da[ed �l Ct� 201 .3 � A. This is�e Anuual Report for[he period Gom L�n'WLEd v Z-�� to - ZU �(the `Report Period" ; or �('CPrr� � ❑ B. This is thc Final Report for thc period Rom � �� , (the 'Rcport Pcriod"), and is f led Cor the following reason: 1. �a death of the Incapacitated Person. Date of death: f�amc of Personal Representa[ivc: 2. "Phe Guardianship was terminated by the Court by Decree of J., datcd ��c-oz .�.. �o.i3oe Page 1 of5 � Estate of � � �7on�L'�U ✓L� . An Incapaeimied Person IL SUbI�I.aRY A. State the value of the esta[e reported on the Inventorv $ �5 3 �q 5� � 3 [3. State the value(s) of pcincipal assets at[he be�inning of sa Ui7�S �L��5'b � C{Tp�(Crn � the Report Period. (Same ns Inventory if fics[ Repon, � �, c6�t� � 4 2 othenvise, ending balance from last ReporL) ��}{�j_q1�--��_�_�''�j-DU � C. What is [he to[al amount of income eaencd during [he ReportPeriod? $ �'S�nV �a�1/�� X� D. What is the rotal amount of incomc and principal y�l� � 7� spent for all purposes during tlie Report Period? $ � I L". Wha[are [he balances remaining a[[he end of thc Rcport Periud? I. Principal $ 2. Income $ 3. Total of Principal and Income $ ) � c40.00 'f' �nUrne wo3 i-�-n�n.aft ,��aC +a dc'su��P�/ ao(u.Lt �llv�� F,- 2�GtnE�-(J(,nsl�I. iP �(C�✓CL� iq *-eb ✓uar,� 20�3 III. �ADDITIONAL INF()72MATION (If more spnce is neede�l, please atmch nddi/iona[pages J A. Principal 7. How is the principal balance lis[ed above cucrendy invested? (Please specify, e.g., real estate, certifica[es of deposit, �estricted bank accounts, etc.): � t li�C �✓l.� Cl/✓�t� sa V i ✓lo�,n Q�C'i2.ac-c�� J O 2. Have the�e been any expenditures from thc principal during the Report Period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .�Ycs ❑Na Ifycs: a. Have all expc�di[ures from the principal been Por the sole benefit of[he Ineapacitated Person? . . . . . . . . �Ycs ❑No ro.,,�aaz .Qo_m»ac Pagc 2 of 5 Estate of /� �.� � u��Cc✓C� � , An Incnpanta[cd Person h. Lis[�urpose and amount of esper.ditures: �� sr h�,+-ie eur� � 29 170 i`r�SGIV - CPS � CCS IiIS S+Y�-4� t ✓{ > ��-- A d-�—��n�. -r 5 3 1 s7 7 � hn✓,+uce.� ,� I � 9 p a �Vas ourl approval r ceived prior to ��/ expendine[he principal'? ❑ Yes dNo . . . . . . . . . . . . . . . . . . . . . . . 3. Were addi[ional principal asse[s received during the Report Period which were not included in [he Inventory or a prior Rcport filed for the Estate? . . . . . . . . . . . �Yes (�No If ycs: a. Was Court approval reques[ed prior to receiving [he additional principal? . . . . . . . . . . . . . . . . ❑ Yes ❑ No b. S[a[e the sources and amounts of the addi[ional principal received: � _ $ $ $ $ R. Income L State sources and amounts of income received during the Keport Period (e fi., Social Security, pension, rents, etc.): .Sn�'u.l S� C[.� r.�z�/ � �S z � 9�� --�5 �' N�_� r�-�l $�Z'[ L��2 .. _�L�-iF d�'r ' I�.t t 'rnn $ 7 I_��ZS', J� � $ $ atSSr � $ I ��r, �af.,m Tatal income received during Repor[ Period: $_ �"? �`f Z0.00 ro-,,,c-oz re,�_m.ie.ne Page 3 of 5 Estare of � �� D�p� Lc Vol � . An Incapacimred Person 2. F�low is income currently invested? (Plcase specify,e.g., �estricted bank aceounts, client cam account, etc.): L � P c�-c nc� + sa v e�q s Q c e�rru-+� c� Cred � t (,trtru i i� fas� /� I �; ,�,ock�.� Ma,t',1e . 1n��ils Far� at�r.c-u��1- +,'Jaq ��e,y�- � -�'lL� �Privo{ -I-d �� ' r5"� ('�EY✓�� 2��C.•�5 5 . C. Expenses for Care and Maintenance Specil'y what expcnditures we�e made from the principal and ineome for[he eare and main[enance oC the Incapacitn[ed Person (e.g., clothing nursing home,medicine, support, ete.): - ks ✓tu+�� re �i�a�� plus �,lol'��•�� a � � �a�e� r�s-1'r,wu�.,,,� r'rPa� ac�?�r s�'�n� � r,i�' �, �cq P�osl-5 �t� �� I�or/-a-[- �"'�,° fP✓�� cu�e��/ �ptrit»�I�,.0 j{e�"�-� . D. Other Expenditures Specify what othec expenditures were made during the Report Period (Do not include any items staled in response to quest/io� n C above.) —/Gnlvc,l (1� � i Cc� � �� « •�� I E. Guardiads Commissions � List amounts of compensation paid as Guardian's cmnmission and s[ate how amoun[was detennined: Courf �{moim! Mefhod ojDe(ermina[ion ApprovalOblained /l U /� '{� �Ycs ❑No DYcs ❑No Fo.��uoz .e._m.iaoe Pa�e 4 of 5 8stare of l7 v[y-t� 6 U��f,( y� , _qn h�cnpncitatcd Person F. Cannsel Fec Lis[amoun[s paid as counscl fze, and indicatc whe[hec Court approval was obtained. Caurt Amoimt Approvul Ob[QineA V1 CM-Q-� � f,� �{'-�"U✓''1 �P P s � �� 'tei❑Yes ❑ \'a i,JP✓C Occ��( 'q-O✓ SL''�✓�LeS ❑Yes ❑No � l�P �a�-ep� `}a S,�t Cc-�� Q.yi S Gl �/� re fi `� a�� `� 1 verify that the foregoing information is correc[to the best of my knowledge, infoimation and belieF, and that this Vcrifcation is subject to the penalties of 18 Pa.CS. § 4904 relative to u�swom falsification to authorities. ��ara " � � f'�-1.,� ��(i signan,reoJCunrdlan iM1edataie V✓I eY.,/I �Zl �Q� ,v��lcu�>e��ol,,�Fmre(oveo.�n,,,i J Z Q� !c� Da v %� �P� �eme„ c�r �� s �e. eh 17nrs <<��,s�,�,v� 717 - 3�5- 7593 Te(epNnrr¢ r�,,,,r,-oz .��.io.i3.oe Page 5 of 5