HomeMy WebLinkAbout08-31-06 (2)
THR coUlfIT OF CUMBERLAND
IN THE COURT OF COMMON PLEAS
ORPHANS' COURT DIYlsJON
Cumberland County Courthouse
I Courthouse Square
Carlisle, PA 17013
Reoort of Guardian
NOTE:
This report must be submitted in duplicate at least once within the first 12 months after your appointment as
Guardian and at least annually thereafter. If the Incapacitated person dies you must fIle a fmal report within 60 days
of the date of death of the Incapacitated person. Submit report to the above address.
...
...
...
If you are Guardian of the Estate only, please fill out sections A, B & D
If you are Guardian ofthe Person only, please fill out sections A, C & D
lfyou are Guardian ofthe Estate and Person, please fill out all sections
Please Print or Type:
(to be completed by ALL Guardians)
SECTION A
Name oflncapacitated Person William Jumoer
Date of Appointment of Guardian Seotember 8. 2005
File No. 21-05-147
Name(s) and Address(s) of all Guardian(s) - Indicate whether Guardian ofthe Estate, Guardian ofthe Person, or Guardian of the
Estate and Person: IKOR Incorporated - Guardian of Estate. PO Box 287 Y orklvn. DE 19736
Faith. Hone and Love Guardianshio Service. Inc. - Guardian of the Person. PO Box 2027. Harrisburg. PA 17104
Daytime telephone NO.ofat least one Guardian (610) 444-1454
The Incapacitated person is: Living _ or Deceased X.
If Deceased, the date of death was June 1. 2006.
(attach a death certificate)
If Living, the current address of the Incapacitated person is:
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This report covers period from Sentember 8. 2005 to June 1. 2006.
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(to be completed by the Guardian of the Estate)
SECTION B
The Guardian's Inventory was filed on:
Was there a Formal Account filed:
Date of filing:
Current Value of Assets (principal) is:
Cash
Checking Account
Stocks and Bonds
$
$ 62.212.52
$ 300.833.79
$
$
$ 363.046.31
IRA's
Real Estate (provide Address)
TOTAL Current Value:
Income of the Incapacitated Person:
Social Security
Pension
Interest and Dividends
Other (Describe)
Monthly
$ 1.202.00
$
$ 221.49
$
Annually
$
$
$
$
TOTAL Income for the Report Period:
$ 183.042.88
List all expenditures made since the last report including the dates of expenditures, the amount, to whom it was paid and for what
reason. (attach additional sheet(s), if necessary)
TOTAL Expenditures for Report Period as detailed below:
$ 120.830.36
Shelter (Rent, Nursing Home, etc.) $ 86.186.79
Medical Expenses $ 6.352.68
Other Ordinary Expenses $ 17.778.37
List the needs ofthe Incapacitated person for which the Guardian has provided since the last Report. (attach additional sheet(s), if
necessary)
2
(to be completeCl oy me uuarCllan or me yersonJ
SECTION C
The type of placement of the Incapacitated Person is:
(Private Residence, Nursing home, Residential treatment facility, etc.)
The major medical or mental problems of the Incapacitated Person are:
(attach additional sheet(s) if necessary)
Describe the Incapacitated Person's living arrangements and the social, medical, psychological and other support
services shelhe is receiving: (attach additional sheet(s) if necessary)
What is the number and the length of times you have visited the Incapacitated Person in the past year?
What is your opinion as to whether the Guardianship should continue or be tenninated or modified? Please give your reasons for your
opinion.
(To be completed by ALL Guardians)
SECTION D
Is there any additional information you wish to provide to the Court regarding the Incapacitated Person?
Must be si20ed b): ALL Guardians:
IKOR Incorporated. Guardian of the Estate
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Date: Aueust 15.2006
3
(all UUarOlanS)
VERIFICATION
I/We IKOR Incorporated verify that the facts set forth in the foregoing report are true and correct to the best of my lour knowledge,
information and belief. I/We understand that false statements herein are made subject to the penalties of 18 Pa.C.S. 94904 relating to
unsworn falsification to authorities.
Must be sismed b): ALL Guardians:
IKOR IncoIJ>orated. Guardian of the Estate
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Candy L Booraem. Personal Needs Coordinator
Date: August 15. 2006
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CO......ONWEAL TH OF PEliNSVL'/ANlA. OEPARTMEIH Of IiEAL TH . VITAL RECORDS
CERTIFICATE OF DEATH
.-.--wrnram T. Jumper'P---. ..-.-.-.
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Camp Hili, PA 17011 ----.. Cumberland I..,,'" "<:' ~ :"'."'" .'': ..t.,
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William Jumper Sr.
Isabel NA
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Alfred 0, Sloan
PO. Box 2027 Harrisburg. PA 17104
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Indiantown Gap National Cemetery
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Annville. PA 17003
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Wallaeo Funeral Directors. 'nc. 106 Aghes Street Harrisburg, PA 1710-4
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