HomeMy WebLinkAbout09-09-15 �;
ANNUAL REPORT OF
GUARDIAN OF THE ESTATE
,-..,
C-=? �
c-� �, _-� rn
cQ �n �-,
COURT OF COMMON PLEAS OF .�� �� �r> > �,,
CUMBERLAND COUNTY,PENNSYLVANIA;:'. --:? `.�, � � c�.�
ORPHANS' COURT DIVISION ��" - t� '�
� .;
. _: .. c.r� -.:,
' .-,
, , � .�.�
�3 �!
� ___ 'r,-�
Estate of MARTHA JEAN McCURDY , an Incapacitated'P�rso�%� r�
C�) �''� �'1
� S
No. 21-�014-0815
I. INTRODUCTION
Robert McCurdy ,was appointed
�Plenary �Limited Guardian of the Estate by Decree of
Thomas A. Placey , J.,
dated October 15, 2014
October 15 2014
� A. This is the Annual Report for the P O15d fro(the "Report Period"); or�
to Se�tember 15
� B. This is the Final Report for the period from �
to , (the"Report Period"), and is filed
far 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
Page 1 of 5
Form G-02 rer. 10.13.06
�"�
Estate of MARTHA JEAN McCURDY , An Incapacitated Person
II. SUMMARY
A. State the value of the estate reported on the Inventory $ 9,000.00
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.) $ 9,749.82
C. What is the total amount of income earned during the
Report Period? $ 7,958.97
D. What is the total amount of income and principal
spent for all purposes during the Report Period? $ 7,958.97
E. What are the balances remaining at the end of the Report
Period?
1. Principal $ 9,412.41
2. Income $
3. Total of Principal and Income $ 9,412.41
III. ADDITIONAL INFORMATION
(If more space is needed,please attach additioraal 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.):
Principal balance is invested in an individual retirement account asset which
is held and administered by the Knights of Columbus. (See attached
statement.)
2. Have there been any expenditures from the principal
during 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 rev.10.13.06 p�lg0 2 Of S
Estate of MARTHA JEAN McCURDY , An Incapacitated Person
b. List purpose and amount of expenditures:
Health and maintenance $ 7,958.97
$
$
$
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? . . . . . . . . . . . . . . . . ❑ Yes ❑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.):
IRA-required minimum distribution for 2014 $ 635.97
Social Security-October to December 2014 $ 1,797.00
Social Security-January to September 2015 $ 5,526.00
$
$
$
Total income received during Report Period: $ 7,958.97
Fo,�,n c-oz rer. 10.13.06 Page 3 of 5
Estate of MARTHA JEAN McCURDY , An Incapacitated Person
2. How is income currently invested? (Please
specify, e.g., restricted bank accounts, client
care account, etc.):
Mrs. McCurdy's primary source of income, i.e. her Social Security
Retirement, is not invested. Her individual retirement account is invested
with the Knights of Columbus.
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.):
All income is used for clothing,health care needs and support.
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.)
No expenditures other than health, maintenance and support were made.
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
No commissions taken. �Yes �No
0 Yes �No
Form G-02 rer.10.13.06 Page 4 of 5
Estate of MARTHA JEAN McCURDY , An Incapacitated Person
F. Counsel Fee
List amounts paid as counsel fee, and indicate whether Court approval was obtained.
Court
Amount Approval Obtained
�Yes �No
No counsel fee taken.
�Yes �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 the penalties of 18 Pa.C.S. § 4904
relative to unsworn falsification to authorities.
�/ �/I�- ��,.�-_� ''�,/�`� G��'Y
-�
Date Signature ofGuardian ofthe Estate �
�'cn�,�'-� I�<�',� ����
Name of Guardiatt of the Estate(rype or pnnt)
�l � G'Ll.f� �/�'/ L- Zj�/ `S-7
�r �
Address
(� c�s,�t' /-{; �L- �'� / i v�� -
�<
Ciry,State,Zip
���� �j �r (✓" � l%- 1
Telephone
Form G-02 rev.10.13.06 Page 5 of 5
Knights of Columbus Type: 4 IRA
One Columbus Plaza Substitute Form 5498
PO BOX 1670 OMB NO. 1545-0747
New Haven CT 06507-0901
E.I.N. 06-0416470
THIS DOCUMENT ISSUED AS A YEAR 2013 TAX STATEMENT FOR FORM 5498 AND/OR FORM1099-LTC
2013 Statement for ParticipanYs Tax Qualified Account for Period Ending: December 31, 2013
MARTHA JEAN MCCURDY Contract No: 03135013
11 DULLES DR W Taxpayer ID No: XXXXX8386
CAMP HILL PA 17011-1111 -
Box 1 Traditional IRA Contributions for2013 $.00
Box 2 Rollover Contributions $.00
Box 3 Roth IRA Conversion Amount $.00
Box 4 Recharacterized Contributions $.00
Box 5 Fair Market Value of Account $9,749.82
Surrender Value $9,495.27
Box 6 Life insurance costs included in Box 1 $.00
Box 7 This Account Is a IRA
Box 8 SEP Contributions $.00
Box 10 Roth IRA Contributions $.00
Box 11 Required Minimum Distribution Y
Box 12a Required Minimum Distribution Date December 31, 2014
Box 12b Required Minimum Distribution Amount $629.02
The surrender value reflects the charges, if any, which would have been taken if the policy had been terminated on
December 31, 2013.
The information on this substitute Form 5498 is being furnished to the Internal Revenue Service.
You may use the amount shown under Box 1 less the amount paid for life insurance, if any, when calculating the
amount paid into the IRA. If this is a Traditional or Roth IRA and the contribution is greater than$5,000.00($6,000.00
if age 50 or older), please review your records. Report any correctians to the Policy Taxation Department at
policv.taxation(c�kofc.orq or 1-800-380-9995 extension 4638. The amount contributed cannot exceed the amount
permitted by law.
Form 5498 will be mailed in May to all IRA policyholders who made deposits for the 2013 tax year.
The Knights of Columbus does not track nondeductible contributions. If you made nondeductible contributions to a
traditional IRA for the 2013 tax year, you must file IRS form 8606 with yourtax return.
Knights of Columbus Type: 4 IRA
One Columbus Plaza Substitute Form 5498
PO BOX 1670 OMB NO. 1545-0747
New Haven CT 06507-0901
E.I.N. 06-0416470
THIS DOCUMENT ISSUED AS A YEAR 2014 TAX STATEMENT FOR FORM 5498 ANDlOR FORM 1099-LTC
2014 Statement for Participant's Tax Qualified Account for Period Ending: December 31, 2014
MARTHA JEAN MCCURDY Contract No: 03135013
11 DULLES DR W Taxpayer ID No: XXXXX8386
CAMP HILL PA 17011-1111
Box 1 Traditional IRA Contributions for 2014 $.00
Box 2 Rollover Contributions $.00
Box 3 Roth IRA Conversion Amount $.00
Box 4 Recharacterized Contributions $.00
Box 5 Fair Market Value of Account $9,412.41
Surrender Value �9�173•$�
Box 6 Life insurance costs included in Box 1 $.00
Box 7 This Account Is a IRA
Box 8 SEP Contributions $.00
Box 10 Roth IRA Contributions $.00
Box 11 Required Minimum Distribution Y
Box 12a Required Minimum Distribution Date December 31, 2015
Box 12b Required Minimum Distribution Amount $635.97
The surrender value reflects the charges, if any, which would have been taken if the policy had been terminated on
December 31, 2014.
The information on this substitute Form 5498 is being furnished to the Internal Revenue Service.
You may use the amount shown under Box 1 less the amount paid for life insurance, if any, when calculating the
amount paid into the IRA. If this is a Traditional or Roth IRA and the contribution is greater than $5,500.00 ($6,500.00
if age 50 or older), please review your records. Report any corrections to the Policy Taxation Department at
policy.taxation(a�kofc.orq or 1-800-380-9995 extension 4638. The amount contributed cannot exceed the amount
permitted by law.
Form 5498 will be mailed in May to all IRA policyholders who made deposits for the 2014 tax year.
The Knights of Columbus does not track nondeductible contributions. If you made nondeductible contributions to a
traditional IRA for the 2014 tax year, you must file IRS form 8606 with your tax return.
Your New Benefit Amount z9z5921
BENEFICIARY'S NAME: M JEAN MCCURDY
Your Social Security benefits will increase by 1.5 percent in 2014 because of a rise in the cost of
living. You can use this letter when you need proof of your benefit amount to receive food,
rent,or energy assistance; bank loans; or for other business. Keep this letter with your other
important financial documents.
How Much Will I Get And When? �
• Your monthly amount (before deductions) is $'739•9�.
• The amount we deduct for Medicare medical insurance is $113.80.
(If you did not have Medicare as of Nov. 14, 2013
or if someone else pays your premium, we show $0.00.)
• The amount we deduct for your Medicare prescription drug plan is $27.10.
(If you did not elect withholding as of Nov 1, 2013, we show $0.00.)
• The amount we deduct for voluntary federal tax withholding is $0.00.
(If you did not elect voluntary tax withholding as of
Nov 14, 2013, we show $4.00.)
• After we take any other deductions, you will receive $599.00
on Jan. 3, 2014.
If you disagree with any of these amounts, you must write to us within 60 days from the date
you receive this letter. We would be happy to review the amounts.
You may receive your benefits through direct deposit, a Direct Express°card, or an Electronic
Transfer Account. If you still receive a paper check and would like to switch to an electronic
payment, please visit www godirec�org or call 1-800-333-1795.
What If I Have Questions? N
Please visit our website at www socialsecurity.gov for more information and a variety of online � �.
services.You also can call 1-500-772-1213 and speak to a representative from 7 a.m.until 7 p.m., ,
Monday through Friday.Recorded information and services are available 24 hours a day. Our lines are
bus�est early in the week,ea:ly in the month,as well as during the week bet�,�een Christm�as and 1�Tew
Year's Day;it is best to call at other times.If you are deaf or hard of hearing,call our TTY number,
1-800-325-0778.If you are outside the United States,you can contact any U S. embassy or consulate
' of�'ice.Please ha�e your Social Security claim number available when you call or visit and include it on
any letter you send to Social Security.If you are inside the United States and need assistance of any kind,
you also can visit your local office.
SUITE 810
555 WALNUT STREET
HARRISBURG PA
Your New Benefit Amount �94694
BENEFICIARY'S NAME: M JEAN MCCURDY
Your Social Security benefits will increase by 1.7 percent in 2015 because of a rise in the cost of
living. You can use this letter when you need proof of your benefit amount to receive foad,
rent,or energy assistance; bank loans; or for other business. Keep this letter with your
important financial records.
Haw Much Will I Get And When?
• Your monthly amount (before deductions) is $752.90.
• The amount we deduct for Medicare medical insurance is $114.20.
(If you did not have Medicare as of I'�Tov. 20, 2014,
or if someone else pays your premium, •,�e show $0.00.)
• The amount we deduct for your Medicare prescription drug plan is �24•�d.
(If you did not elect withholding as of Nov. l, 2014, we show $0.00.)
• The amount we deduct for voluntary Federal tax withholding is ��•fl�.
(If you did not elect voluntary tax withholding as of
Nov. 20, 2014, we show $0.00.)
• After we take any other deductions, you will receive $b14.00
on or about Jan. 2, 2015.
If you disagree with any of these amounts, you must write to us within 60 days from the date
you receive this letter. We would be happy to review the amounts.
You may receive your benefits through direct deposit, a Direct Express°card, or an Electronic
Transfer Account. If you still receive a paper check and want to switch to an electronic
payment, please visit the Department of the Treasury's Go Direct website at www godirec�org.
What If I Have Questions? �
Please visit our website at www socialsecurzty.gov for more information and a variety of online �
services.You also can call 1-800-772-1213 and speak to a representative from 7 a.m.until 7 p.m.,
Monday through Friday.Recorded information and services are available 24 hours a day. Our lines are
busiest early in the week,early in the month,as well as during the week between Christmas and New
Year's Day;it is best to call at other iimes.If you are deaf or hard of hearing,call our TTY number,
1-800-325-0778.If you are outside the United States,you can contact any U S. embassy or consulate
office.Please have your Social Security claim number available when you call or visit and include it on
any letter you send to Social Security.If you are inside the United States and need assistance of any kind,
you can visit your local o�'ice.
SUITE 810
555 WALNUT STREET
HARRISBURG PA