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Home My WebLink About09-03-15 .'� I - /C' c(�� . � � � �; , „ - -�, � �� - :�� ANNUAL REPORT OF � ' ' " � � GUARDIAN OF THE ESTATE ``' COURT OP COMMON PLEAS OF � �- � " �- o CUMBERLAND COUV"fY, PENNSYLVANIA u� � -�� ORPHANS' COUR�I�UIVISION Estate of Y-+�iYI�G �v��e �'ha�p�= ,��( F��'��' '�r , an Incapacitatcd Ycrson No. I. INTRODUCTION ��J 1 7�� ,Coc�r«< ,�"hui� �wpasappointcd �'Pleuazy ❑Limited Guazdiau of thc Estatc by Dccmc of�/,�a f��e-/�r ,�'!�n%�r , J., dated �lu�.s� ��, O/C : ❑ A. This is the Annual Report for the period from u 'L E% Oi` to S o%k6e� 3 , 9G/S (the ` epo� ❑ B. This is the Final Report for the period from , [o , (the"Report Period'�, and is filed for the following reason: 1. The death of the I�capacitated Person. Date of death: Name of Personal Rcpresentative: 2. The Guardianship was te�minated by the Court by Decree of J., dated ro.m c-oz .ev_m_�3.oe Page 1 of 5 /') , `—A Estate of ��,5/�c c�vzf�e �a.�P �3G �-nUti.�/ti 57� , An Incapacitated Person (�u��l,Pa i�6�3 II. SUMMARY A. State the value of the estate rcpo�tcd on thc lnventory $ B. Shte the value(s)of principal assets at the begimii�g of the Report Period. (Same as Imentory if first Report, otherwise, ending balance from last Report.) $ C. What is the total amount of incomc camcd during tlie RepoR Neriod? $ D. What is the total amoun[of income and principal spent for all purposes during the Report Period? $� E. What aze the balaoces remaini�g at the end of t Report Period? 1. Principal $ 2. Income $ 3. Total of Principal and Income $ 0.00 III. ADDITIONAL INFORMATION (I,fmare space is needed,please attach additional��ages.) A. Principal 1. How is the principal balance listed above curreutly invested? (Please specify, e.g., real estate, certifieates of deposit,restricted bank accounts, etc.): 2. Have there been any expenditures from the principal duringthe Report Period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes �iVo If yes: a. Have all expendituces from the principal bcen for Ihe sole benefit of the Incapacitated Pe�son? . . . . . . . . 0 Yes '�dt�o Fo.m c-oz .��_�o.e.oe Page 2 of 5 Estate of �5'� GnoN�/ti 9' �'Co�Gs� �p J 70i� , An Incapacitated Pecson b. List pu�pose and amount of expenditures: - $ $ $ $ c. Was CouR approval received prior to expending the princip2l? . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes C3-K�o 3. Wece additional principal asscts rcccivcd during the RepoR Period which were not included in the Inventory or a prior Report filed for the Estate7 . . . . . . . . . . . � Yes �o If yes: a. Was Court approval requested prior to ieceiving the addi[ional priucipal? . . . . . . . . . . . . . . . . ❑ Yes �.Pdo b. State the soumes and amounts of die additional principal received: $ $ $ $ $ B. Income 1. State sources and amounts of income received during the Report Period (e.g., Social SecuriTy, pensioq rents, ete.): $ $ $ $ $ $ Tota] income received during Report Yc�iod: $ o.00 ro.m c-oz .e�. io_isna Page 3 of 5 Estate of ��l %Hati,��ti Sf /��/5�� f I70�� , An Incapacitated Pe�son 2. How is income c�rre�tly invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): C. Expenses tor Care and Mainten:mce Specify what expenditures were made from the principal and income for the care a�d maintenance of the Incapacitated Person (e.g., elothing, nursing home, medicine, support, etc.): D. Other Expenditures Specify what other expendimres wcrc made du�ing the Report Period. (Do not include any items statcd in response to question C above.) F,. Cuardiads Commissions List amounts of compensation paid as Guardiads comcuission and state how amount was dctcrmined: Court Amoun� Method ojDe�errnina�ion Approva7 0btained ❑Yes �`Vo ❑Yes [dne�� Fo„�c�oz .��_m.�s.oe Page 4 of 5 Estate of r�-3L �an�E�u Si �<u�5� � �� 7D/.3 , An Incapacitated Person F. Counsel Fee List amounts paid as counsel fee, and indicate wl�ether Court approval was obtained. Court Amount Approval Obtained [}Yes ❑No QYes ❑No I verify that the fo�egoing information is correct to the best of my knowledge, information and belief; and that this Verification is subject to the penal[ies of 18 Pa.C.S. § 4904 relative to unswom falsification to authoritiea � j�so,/�.�6y2 3 i�OiS /�� p¢�¢ Si�mre nJGuard�an 1�he Esmre ��w.G�� Oh�'� T'orneo(CuarRian IMe£sm[e(ry'peorPnn!) �.�� ira,c.�/� 5% Addrezv l�/s� �� /�� Clry',S�me.Lip �/7 �� I'rl�ph e ro.,n c-oz .ev. m.�s.ne Page 5 of 5 ANNUAL REPORT OF " ^ � � GUARDIAN OF THE PERSON ~ � �' ' � , , l , � �� COURT OF COMMON PLEAS OF � �' -; COUNTY, PENNSYLVANIA cn �_ �,} ORPHANS' COURT DIVISION �`? o c.� '� /-��SH4 �ve��C �Ga�2 Estate of �� *��k1.� .sf /�'./,3/ Pff /7O/� , an Incapacita[ed Person No. I. INTRODUCTION 7 �� ,^,�<(��° ��c , was appointed �"Plenary�Limited Guardian of the Person by Decree of ,J., dated /�u�< � [vf�A. This is[he Annual Report for[he period from o u �- 6' �i/5� ro�Sro.Le�.S« r �3 �,��([he` eport PecioB'); or ❑ B. This is the Final Report for the period from �o (the"Report Period"), and is fileA for the following reason: l. The death of the Incapacitated Person. Date of death: 2. The Guardianship was terminated by the Court by Decree of J., dated For a Fina[Report,amit Sections 77[hrough/V. po.m uos re�. io�3.oa Page 1 of 4 � µC,a-��. c�'u�N� .3has.�P Estate of �3C Fiv.✓kl..� ST �o�la�r PP l�Li an Incapacihted Pecsou II. PERSONAL DATA AgeofthelncapacitatedPerson: `� DateofBirthyN�u�� k � /y�// III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: �3G F«a.�L/0 5T C'GrJSGP� P� I7O/.3 B. The�I,n�capacitated Persods reside�ce is: �own home/apartment ❑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 Incapacita[ed Person has moved within Ihe pu[year, state prior residence and reason(s) foc move: i�o,mc-o3 �e�. io.ii.oe Page2of4 �LiS'4�4. CJen4 �/�4Ap¢. Estate of �3� FxaNk�-ti si �nJ�s�e f� /7� , an Incapacirated Person D. Name and address of the Incapacitated Person's primary caregiver. � IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: h�ak�� a� C'�.�.�/< �e�i,�[ ,Se.z�«s �ud�lo�, w�,� fektly . ��i. he,� (�aPpnc„L� ,fo{ I'ece.✓i p�,.�e✓aL.�le N�.�cL,o� E'�tYLL.uely a.urP � r�Fe C�U�v" �s,2nv.u.cY�✓a c�eCi3'.cti5 . L°" B. Specify what, if any, social, medical,prychofogical and support services the Incapacitated Person is receiving: q � . ' l�He �� L i� � 24iuiu� �'/C� �Rr/JS �u,�cE.y �'i^.,�aeC f��,�L_/�iy�/.aS Q1��5 Y J.`P�vaL Q�'iyw /�'OGw�,� OF��C�/ � i V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardiaoship should: �continue ❑be modified ❑be termi�ated H�o.m c-0e .e�. io.aoe Page 3 of 4 RL�U fi��/,�e ��v� Estateof �.jL �iau.��" 5� ��-4.��< �/f �7�.C� .anlncapacitetedPerson The reasons for the foregoing opinion are: B. During the past year, the Guardian of the Person has visited the (ncapacitated Person [imes wi[h the average visit lasting hours, minutes. The repart af a socia!service organimtlon emplayed by the Guardian!o oversee and coordinate !he care ojthe lncapaci7ated Person for the period covered by this Report may be a�mched!o supplemen!this Repar�. I verify that[he foregoing infortnation is cortect to the best of my knowledge, infortnation and belief, aod that this Verification is subject to[he penal[ies of 18 Pa. C.S.A. § 4904 relative to unswom falsification to authorities. � Sv, ,fP,.,52a 3 30�5 �� oare�'� s�g n„e/�� / > ��OuG/c� {�. - Ce/e1< Nnme ofGuardian of�he Pnnon(ry4e orprimJ � �J � ��N S� Addrerv �l��.s� Q� J7D�� Ciry.Smre,Zip �/7� .15�'—�/�7�/C� reiey „e Fo.m c-m .... ro u.oe Page 4 of 4