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HomeMy WebLinkAbout09-20-07 (2) ANNUAL REPORT OF GUARDIAN OF THE PERSON COURT OF COMMON PLEAS OF C u Wth 0 xLQv\dcOUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of \-6..\nr~ T. '(}uci ( d~ No. 1ffiLQ- q OS . an Incapacitated Person I. INTRODUCTION _N e\~ \r\ \oorV\oocl S eXV\ (Q,<:; . was appointed ~enary OLimited Guardian of the Person by Decree of j L\d~. G I Ad 0 , J., dated II -17 - Oll> o A. This is the Annu.~eport fur the period from l.l- 11. - d l1> , to --U-=.11:0 L , (the "Report Period"); or o B. This is the Final Report for the period from to (the "Report Period"), and is filed for the following reason: 1. The death of the Incapacitated Person. Date of death: 2. The Guardianship was terminated by the Court by Decree of ,. I.. _:}'r,-d~t~4,__'.:, 10 .L;~\ !'......'.__' '~~1:"'. ,.,,J--.J =:.J ).:;:JJ-18 For a Final Report, omit Sections II through IV. I I IIJ 0'" '""'0,/,-117 I : Ii' G Cl..J.:l _I:UIJ Form G-03 rev, 10.13.06 Page 1 of 4 o.i Estateof-1+0VV.'Lj ,. ~ . an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person: U 0 Date of Birth: 1 - 2 ~ - 1!L 4 '7 ID. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: ffi CA-v)CX' Cax~ Ch ~J,rsLL q4D WClLV\6t bottOfY) ~cl, CQ(Lr~k ) i?A t1013 B. The Incapacitated Person's residence is: D own home / apartment ~ursing home D boarding home / personal care home o Guardian's home / apartment o hospital or medical facility D relative's home (name, relationship and address) o other: C. The Incapacitated Person has been in the present residence since LQ - tLP - 0 CJ . If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: Form G-03 rev. 10.13.06 Page 2 of 4 Estate OCt\- o..rrlj I. ducht . an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: m~VlOt mf -t) wrLI'Su- IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: . ~CL W \'\-V\ ~(QSS,(Jt'\ /"'0 . ^ 0\ \ "'~ ^ (). ) UJI \.A)\ LiUL~~J..lA..^%Y\A) CO r-O l\QVY CLm tY"'oS ClQ.r O<;l S ) CoIlq[.'STiVQ V\QQr-~ 'RuLur.e W\cl~ o\JseO.s~ d.t'Q~t-JLs. m \)0 to,x-ch 'OJ if\ R:t \fC tt 'on. I I I . (~~) B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: .~~~~~ lk& ~) V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: ~inue o be modified o be terminated Form G-03 rev. 10.13.06 Page 3 of 4 Estateod\.o.AJ\1j 17 ~^ Jl1<t , an Incapacitated Person The reasons for the foregoing opinion are: '-- ~ ()JlQ. vY\er. ~ ~ .t-Vu- B. During the past year, the Guardian of the Person has visited the Incapacitated Person '3 times with the average visit lasting hours, _I Q minutes. The report of a social service organization employed by the Guardian to oversee and coordinate the care of the Incapacitated Person for the period covered by this Report may be attached to supplement this Report. 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.A. ~ 4904 relative to unsworn falsification to authorities. ~ ~ ~ ---3...=...t1 - 0"" ~\ 0 Crl h b--yir"'j(')('J ~ 1\1\ roc:, Date ~dlan of the Person NeS:~Yin()()rl ~X-Vl(Q~ Name ofG man of the Person (type or pnnt) l'lSliIUIUlUlUUU SIllVICI'S 134 SOUTH PRINCE STREET P.O. BOX 15!)3 LANCASTER, PA 17608-1595 Address City, Stale, Zip (In) 609-1-Z2\ Telephone Form G-03 rev. 10.13.06 Page 4 of 4 09/17/2007 15:18 71 72498223 CARLISE EAST PAGE 81/81 HeR · ManorCare Printed on: 6127/200712:05:24 ET ADMITTING RECORO MCHS Carlisle ~o W.!I1llt llottelll ""'d C'rl~lf, '"" 17C11~ l'H) 2<1~!\ , Ludy HlJIrry . ,.j 241Jt CARLISLE REGIONAl.. MI!OlCAI. CENTeR :l20.C ) ~ I _ _, 1 j~M~$ffRiOf~"tTM.OP'rAr~SfAy'6.A;.1i'~4~f.~."'4~r...~unf"""f'"......."~.uQ~iafNAC^'f\Mls8i~ltSiTf~...;Nrrj;~~ACM<iSiioN.l)l"ti..(MOef)'H'~"'h~."'.""."'.""'''..I''''.''''''-''OU.~&'Nf''\6'M~5Sio~rbATi'u.~ j $/412005. el1 S~05 7/2212004 7/2212004 6/1612005' l ~"I't'f'fy'f/_,""'I-~J~~~'Ht't'~'ff#...,..,~'~""fIt'f1'"'i''''''I'''r'_....<lflJif1ft''''~''H~'''.............u~f_H''"'''''~I''_.''......\i ~~~~~'.~l"'''...'..:-.. '1;> ""..:i'i1l. I^ j Mr. Harry JUdy , 208-39-7361. . ! 1.;O''Si)1!l''tl'..s(;.op!'fi..';.liS"5REss1z7c'iW;v.'n'fii':Zirj.u'........w,..."......_'~..'m_.. 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