HomeMy WebLinkAbout03-08-07
,,-.
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYL VANIA
ORPHANS' COURT DIVISION
INRE:
Myrtle A. Drawbaugh, an incapacitated person FILE NO. 21-06-0650
GUARDIAN OF THE PERSON ANNUAL REPORT .- htJKL-
[20 Pa.C.S.A. 5521 (c)]
FROM
11..--1
, 200~ TO
j,- /(
, 200 ~
1)
I am the
named above.
Prti 6.LlS'{" ~_,
I was appointed Guardian by Order of Court dated MtIl 24, 2006, ~l}.ich \.3 wa~
,~[)
X was not modified by Court Order( s) dated'~,-~
Limited
X
Plenary Co-Guardian of the Estate of my ward,
2)
3)
Is the incapacitated person still living?
If no, answer the following:
;V6
r.....)
I
co
; ,J
-:J
(a) Date of Death 1- /1.....07_
(b) Place of Death tJ13" SfhU ~-rtf f f<(J#1I3 I C/fv.p/-hu f;1:'
(c) Name of Administrator/trix or Executor/trix 01trtf2.o;J L.~~#-
(d) Date Guardian of the Person filed the last Annual Report I 6 - 70 -6 " ( -:t;.J r-r,~
4)
If the incapacitated person is still living, answer the following questions:
(a)
(b)
I 0 -2.D-6~
Date Guardian of the Person filed the last Annual Report?
Current address of the incapacitated person: tV) A-
t
(c) Current age: Date of birth of incapacitated person: { -7- { '1/ ,
(d) The incapacitated person's residence~ wA5
(e)
Ward's own residence
~ Nursing Home
Hospital or Medical Facility
The incapacitated person has been living there since
My home/apartment
Relative's Home
Boarding Home
/VIAtU::4 200 fc
4
r '
5)
Date
If moved within the past year, state from where and the reason for the change:
(f)
I rate her living arrangement as:
1\1/ A-
Excellent
Average
Below Average
Explain:
(g)
I believe she is:
Content with the living situation
Unhappy with the living situation
Unaware with the living situation
!'i1A-
Physical Health
tllk
(a) Current physical condition ofthe incapacitated person is:
Excellent
Good
Fair
Poor
(b) Her major physical health problems are as follows:
( c) During the past year, her physical condition has:
Remained about the same.
Improved. Explain
Worsened. Explain
(d) During the past year, she received the following medical treatment (include
check-ups and dental work):
Ailment
Type of treatment
Doctor's name
2
c .
6)
Mental Health
tllk
(a) The incapacitated person's condition is:
Excellent
Good
Fair
Poor
(b) Her major mental health problems are as follows:
(c) During the past year, her mental condition has:
Remained about the same.
Improved. Explain
Worsened. Explain
(e) During the past year, treatment or evaluation by a psychiatrist, psychologist or
social worker was was not provided. Such mental health services are
briefly described as:
7.
Social Activities/Services
;IlK
(a) Her current social condition is:
Excellent
Good
Fair
Poor
(b) During the past year, her social condition has:
Remained about the same.
Improved. Explain
Worsened. Explain
3
t,/ .
(c) during the past year she has participated in the following activities:
Recreational
Educational
Social
Occupational
No activities available.
She refuses to participate in any activities.
She is unable to participate in any activities.
8) Visitation
(a)
During the last year, I visited her as follows:
2 ~ 3 ,Ie (UA J.uA-
I
(b) The average amount of time I spent on each visit was (... Z- "'^-S .
(c) The last time I visited was on 1-11"'-6 -, (date)
9) During the last year I have performed the following activities on behalf of the
incapacitated person: tIvtrf 'P Lr-n ItLL hrJ /t~ (.( 1:\'- f /l1 (D)( cA<-
1)~C-15ID"'{ f flta> 131U5( Got'lSuLIG'l) W/Clli-GG.IWfiS/crcj
f (leY/ '00 /TrIy fli:1lJOtfltL I{BIAs fI/~CD
10) I believe she has the following unmet needs:
/1 A-
11) The guardianship
modification because:
should
should not be continued without
;'I)K
4
I ..
\'2)
. ' l< sical ot tllenlal well-being
-s ""out the incaI'aC\tated l"'""n s I' J
-please note an':! conceL"
ot the ftna"ces that the Co"" should \alOw:
j t the oua<dian ot the incaI'aCitated l"'tson' s estate. If yes,
\3) I arn~arnno 0
~ort is attached.
. . that the inl'onnation contained in this tcIl"" is uue and
\ CER11l''{ undet the l"'nalttes ot I'e~ut)' . db r et
t \alOWledge \nI'ottOauon an e \ .
co"ect to the best 0 tllY' ( 1.2 t-f1./'1.0Lf"''Z..- (\totlle)
S' '.v?~t /.....1Y'J>.:-.6P<": 1;* -retCl'Mne NO. --? I
Narne: ~ I~
(work)
['1/1 S3/r-511(P
A.ddresS:
i363 Ii: rJ6. C/tffi/d~ (4
~56ull6 fA Pi/7/'
i~3/D'
~~i .12~
Signature
fr-/
Date
send to:
Register of Wms
curnberand Count)' Courthouse
One courthOuse SC\uare
Carlisle, ph \'10\3
('1 \ '1) 240-6345
~I<; h\;.l-l!-)
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